(28) Depression
VIDEO
Prozac
Does Prozac make you aggressive?
I know someone who became violent after starting an antidepressant. Prozac is one of the SSRIs and they all work in the same way by improving serotonin levels in the brain.
There is no hard evidence that any SSRI will make you aggressive. Prozac has a stimulant side-effect profile. Whilst this is not strong, it is noticeable. Thisside-effect can be beneficial - someone who is quite flat and low may feel more alert and stimulated early on in treatment, but this is quite different from the antidepressant effects.
Some people describe the stimulation rather like the effect of a cup of coffee, i.e. pleasantly alerting. This is not likely to make you behave out of character. Did the person you describe have any previous history of aggressive behaviour? If he is quite highly strung or keyed up, e.g. an ‘angry young man’, he may have been better on a neutral or mildly sedative antidepressant.
Lithium
I have bipolar disorder, and have had several spells of elated mood; once I had to stay in hospital. Can I do anything to stop these happening?
Long-term mood stabilising medication can help prevent your moods swinging up and down so drastically. Prophylaxis (meaning preventative treatment) is usually recommended if your moods are persistently unstable, for example if you have had more than one mood swing in 2 years.
Several drugs are used for this; lithium is the best known. It has no direct action as a tranquilliser but stabilises brain chemistry. Other drugs are also used: carbamazepine (Tegretol) and sodium valproate (Epilim), used in the treatment of epilepsy, are also effective as mood stabilisers. Carbamazepine can interfere with the action of the oral contraceptive pill. This will need to be discussed with your doctor. There are also some other drug interactions. Ask your pharmacist if in doubt.
Once you start a mood stabiliser, you will probably need it for a minimum of 3 years. There is some evidence that, if you stop lithium before the 3 years are up, the rate of relapse can increase. A few people need to stay on a mood stabiliser permanently.
I’m on lithium for recurrent mood swings. My doctor says I need blood tests. Why is this?
Lithium is a natural substance and is in the same chemical family as the salt we put on food. Lithium will have little or no therapeutic effect if the level in the bloodstream is too low. If the level is too high, then toxic side-effects occur. For the lithium to be used safely and usefully, a certain blood level of the drug needs to be reached. When you first start lithium, the level of the drug is tested about 5 days later to check that the level is satisfactory. The level of lithium is tested 12 hours after the last dose of lithium.
This will give the average blood level over 24 hours. A few minutes either way is fine, but not an hour or so. The drug dose may need to be raised or lowered, or left the same, depending on the result. Once you are established on lithium, its dose remains fairly settled, and checks need then be done only once every 3 months. If you have a severe gut upset with diarrhoea and vomiting, or you become markedly dehydrated for any other reason, lithium will become more concentrated in the blood, until things correct themselves. Too much sunbathing on a very hot beach or a hangover, for example, can make you dehydrated. If you are unable to keep fluids down, leave off the lithium that day and get in touch with your doctor or nurse. Try to get your fluids back to normal levels as soon as possible. If you do start on lithium treatment, your chemist will give you an information sheet about its safe use.
Toxic side-effects of lithium treatment, i.e. changes seen when the drug level is too high, include a tremor (but this can also occur when the levels are absolutely normal), drowsiness, confusion, giddiness and slurring of speech.
Lithium can transform people’s lives - but it is a drug that needs to be respected.Once a year, blood tests are taken to check kidney function and thyroid gland function. If the kidneys are not working to capacity, lithium levels can become raised into the toxic level.
Lithium is got rid of by the kidneys. After fairly long-term use of lithium, the thyroid gland can slow down.
The thyroid gland regulates body metabolism. If the thyroid slows down, we slow down and can put on weight; mood can also be affected and thoughts can become sluggish.
